PETCO2变化与老年肝脏切除术全麻患者容量反应严重程度的关系

The Relationship between PETCO2 Changes and the Severity of Volume Response in Elderly Patients Undergoing Hepatectomy under General Anesthesia

目的探讨呼气末二氧化碳分压(PETCO2)在评估老年肝脏切除术全麻患者容量反应性的价值。方法选取2017年2月2019年3月在我院行肝脏切除术患者90例,均行容量负荷试验,根据容量反应性结果将患者分为有反应组(容量反应阳性)和无反应组(容量反应阴性),比较两组患者一般资料(性别、年龄、体重指数、APACHEⅡ评分、疾病)及血流动力学参数(HR、MAP、CV、P、CI、PETCO2)变化情况,评估PETCO2预测容量反应性的价值。结果容量反应阳性患者62例,容量反应阴性患者28例,两组性别、年龄、体重指数等一般资料比较,差异无统计学意义(P>0.05);两组容量负荷试验前后HR变化值、MAP变化值和CVP变化值比较,差异无统计学意义(P>0.05);有反应组容量负荷试验前后CI变化值和PETCO2变化值均高于无反应组,差异有统计学意义(P<0.05);容量负荷试验前后PETCO2变化值与CI变化值呈正相关(r=0.549,P<0.05);容量负荷试验前后PETCO2变化值预测容量反应性的ROC曲线下面积为0.904,截断值为2.81 mm Hg时,其评估容量反应性的敏感性和特异性分别为83.00%和97.00%。结论 PETCO2在评估老年肝脏切除术全麻患者容量反应性中具有较高的特异性和敏感性,值得临床应用。

Objective To explore the value of end-expiratory carbon dioxide partial pressure(PETCO2) in the evaluation of volume responsiveness in elderly patients undergoing hepatectomy with general anesthesia.Methods A total of 90 patients who underwent hepatectomy in our hospital from February 2017 to March 2019 were selected. All patients underwent volumetric load testing, according to the volume responsiveness results, the patients were divided into a response group(volume response positive) and a non-response group(volume response negative), and the general information(gender, age, body mass index, APACHE II score, disease) and blood flow of the two groups were compared,the changes of scientific parameters(HR, MAP, CV, P, CI, PETCO2) to evaluate the value of PETCO2 in predicting volume responsiveness.Results There were 62 patients with positive volume response and 28 patients with negative volume response. There was no significant difference in gender, age, body mass index and other general data between the two groups(P>0.05);There was no statistically significant difference in HR change value, MAP change value and CVP change value between the two groups before and after the capacity load test(P>0.05);The CI change value and PETCO2 change value of the response group before and after the volume load test were higher than the non-response group, the difference was statistically significant( P<0.05);The change value of PETCO2 before and after the volume load test was positively correlated with the change value of CI(r=0.549, P<0.05);the area under the ROC curve of the volume change value of PETCO2 before and after the load test was 0.904 and the cutoff value was 2.81 mmHg,the sensitivity and specificity for evaluating volume responsiveness were 83.00% and 97.00%, respectively.Conclusion PETCO2 has high specificity and sensitivity in the evaluation of volume responsiveness in elderly patients undergoing hepatectomy for general anesthesia, and it is worthy of clinical application.